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Journal de Pharmacie Clinique

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Fluindione-induced skin necrosis in a patient with protein C deficiency Volume 24, issue 2, avril-mai-juin 2005

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Authors
Service pharmacie, Centre hospitalier Lyon Sud, Pierre Bénite, Service de dermatologie, Hôpital Edouard Herriot, Lyon, Centre régional de pharmacovigilance de Lyon, Lyon

Skin necrosis is a rare but potentially severe complication of oral anticoagulant therapy. We report a case of fluindione-induced skin necrosis in a 31-year-old man with protein C deficiency and a familial history of multiple thromboses. After having received fluindione for several years, this patient spontaneously decided to discontinue his treatment. A new episode of venous thrombosis occurred 2 months later and fluindione was restarted. Skin necrosis was noted 8 days after and fluindione was discontinued. Cutaneous lesions improved and fluindione was later successfully reintroduced under heparin and protein C infusion. This case indicated that intermittent non-compliance or reintroduction of fluindione may explain the late occurrence of skin necrosis in a patient with protein C deficiency who previously tolerated this treatment.